Maryville Nurs 623 Exam 1.100% ACCURATE SOLUTIONS GRADE A+

Basics with skin conditions •Alopecia •Rash •Pruritus •Uticaria •Pigmentation change Skin lesion—New vs. Change HPI questions for skin problems Duration of symptoms Precipitating factors •Medications •Food •Occupation •Outdoors •Hobbies/Sport participation •Exposure to insects •Jewelry/metals/chemicals •Family history Is it: Local or systemic Pruritus- all day or worse at night Uticaria - duration Pigmented changes Pigmentation/Changes of the skin Diff diagnosis Nevi- brown, beige or pink( 5mm) Melanoma Related to pregnancy- melasma (mask of pregnancy) Addison disease Side effect of medication- steroid therapy skin lesions Macule - flat, nonpalpable (freckle, petechia) Papule - PALPABLE, solid elevation of skin (elevated nevus) Nodule - elevated solid mass, deeper and firmer than papule (wart) Tumor - solid mass deep in subcutaneous tissue (epithelioma) Wheal - irregularly shaped, elevated area (hive, mosquito bite Vesicle - elevation of skin with serous (clear) fluid Pustule - similar to vesicle but filled with pus (acne) Ulcer - deep loss of skin (venous statis ulcer) Atophy - thinning of skin Bullae-Clear fluid-filled blisters 10 mm in diameter. These may be caused by burns, bites, irritant or allergic contact dermatitis, and drug reactions. primary versus secondary skin lesions Primary skin lesions are those which develop as a direct result of the disease process. Secondary lesions are those which evolve from primary lesions or develop as a consequence of the patient's activities. Parasitic Skin Infections scabies and lice Scabies Highly contagious infestation that occurs mainly in children, young adults, health care workers, and institutionalized persons of all ages. Subjective: Complaints of intense itching that is usually more severe at night. Objective:Earliest physical sign is small 1 to 2 mm red papules located in areas of body most attractive to mites. Itching, excoriation, , crusting, and scaling may be present making it hard to see scabies. Diagnostics:Ink burrow test Scabies treatment Permethrin 5% cream (Remember you have 5 fingers)- leave on for 8-14 hours then shower- daily for 7 days. Oral antihistamines for itching, topical steroids for itching. The entire household must be treated. Everything should be washed with hot water/detergent, treat any infection that is present. Starve mites by sealing them in a bag for about 10 days. Lice treatment Permethrin 1% leave on for 10 mins then rinse. May repeat in 7 days if needed. Fungal skin infections · Candidiasis- bright, beefy red rash treat with topical antifungal, · Dermatophytoses - the tineas (ringworm) · Onychomycosis treat with Terbinafine for 6-12 weeks (only 73-79% effective, educate patient. · Fungal infections survive on keratin, so considered superficial. · Pathogens: Epidermophyton, trichophyton, microsporum. · Those at risk are DM and immunocompromised. · Diagnostics: KOH Tinea corporis (Ringworm of body) Hx of erythematous round and elevated pruritic lesion that grows in size & starts to clear in the center Miconazole 2% cream BID x4 weeks, Clotrimazole 1%, Terbafine 1% Tinea capitus (ringworm of head) Children common. Painless bald spot, may have kerion that looks like honeycomb, inflammation. Boggy mass containing broken hairs and oozing purulent material from follicular orifices Systemic antifungals - Griseofulvin BID for 2-4 months or 2 weeks after negative cultures. Teratogenic - use 2nd method of contraception. OR terbinafine cream Tinea versicolor (skin, AKA pityriasis versicolor) Round or oval lesions of hypo or hyperpigmentation macule, located mainly on back chest, arms, sometimes neck/face. Sometimes very fine scales seen. Agent P oribiculare causes round, pityrosporum ovale causes oval Clotrimazole 1% cream and solution BID up to 4 weeks Bacterial infections of the skin · Impetigo · highly contagious Cellulitis · Keflex (1st gen cephalosporine) 10-14 days, or dicloxacillin, · PCN allergy use Erythromycin. · non purulent assume staph aureus Purulent cellulitis · I&D first line · NO 1st gen cephalosporine · Consider MRSA- Bactrim, Cleocin, Doxycycline Impetigo Honey crusted plaques, usually on face Bullous: begin as small vesicles that rupture easily with serous fluid turning into crust Nonbullous, vesticulopustular: thick, adherent lesions, dirty yellow-colored crust with erythematous margins Treatment: Clean lesions. Bactroban TID x 7 days. Antibiotic (Keflex, Augmentin, Cloxacillin). With no treatment, it is self-limiting 2-3 wks follilculitis Staphylococcus. Multiple small papules on erythematous base, can be large yellow white tender pustules in adults. Common in places hair is present, widespread is characteristic, bumpy rash, no itching. Treatment: Only if becomes infected. Large lesions cleansed with weak soap solution, followed by soaking with saline or aluminum subacetate BID. TAO can be used BID for 5 days. Oral ABT 1st gen cephalo. if resistant Localized cellulitis The typical lesion of cellulitis is wide, diffuse area of erythematous skin that is warm and tender to palpation. Infection is occasionally accompanied by severe edema. Systemic symptoms such as fever, chills, and malaise may also be present. CAUSES- Diabetic patient or other immunocompromised patients. Any break in the skin. Skin breaks from surgical incisions, skin tears, wounds, trauma, insect bites or stings, and animal or human bites. PREEXISTING conditions- stasis ulcers, dermatitides, viral skin infections, superficial bacterial infections, and bolus disease all have the risk for secondary infections. Subjective- tender, warm, erythematous areas of skin usually on face, CONTINUED.....